Ebola: CDC interviewing “about 100 people” who had contact with Dallas patient, while saying “the only way to get to zero risk is to stop the outbreak in West Africa”

Promising daily updates on the investigation of the first case of Ebola diagnosed in the United States, U.S. Centers for Disease Control and Prevention Director Dr. Tom Frieden expressed confidence today that the disease will be contained in this country, while allowing other people may become sick. Efforts are underway now, he said to interview “about 100 people” who may have had contact with Thomas Eric Duncan since his arrival here. Frieden was joined in the 1p.m. briefing by Texas Health Commissioner Dr. David Lakey and Dallas County emergency operations head Judge Clay Lewis Jenkins. Four people in the home where Mr. Duncan was staying have been quarantined, a police officer outside their door, and “an entity” has been identified today to clean the home, they said.

Mr. Duncan was exposed to Ebola in Liberia when caring for a woman who had been turned away, for lack of room, from a hospital there. He in turn was turned away from the hospital he went to in Dallas, Texas when he first became ill, because health workers did not realize he was at risk for Ebola, although he told at least one where he had just been. The hospital’s failure to retain Mr. Duncan provides “a teachable moment,” Frieden said. Lakey called the hospital “very sophisticated” and said travel histories taken there have led to a series of malaria diagnoses. Officials also faced questions about the condition of the home where Mr. Duncan stayed as he became sick, and the extent to which it had been cleaned, acknowledging “difficulties” in finding “entities that felt comfortable” cleaning the apartment. In the meantime, officials said more people with the disease may arrive, and more people may be exposed.

“The only way to get to zero risk,” Frieden said, “is to stop the outbreak in West Africa.”

The update on what Frieden called “meticulous and rigorous efforts” to track and monitor anyone who had contact with Mr. Duncan comes on the day the agency released its weekly report, which details the steps through which Nigeria and Senegal confronted and contained the disease.

The numbers in Nigeria, after the first patient, Liberian-American Patrick Sawyer arrived sick in mid-July, are harrowing. By the time the last new case had been recorded in Port Harcourt, August 31, 894 people in the country who had had contact with someone sick with the disease had been traced and monitored, 19 people had become sick, and eight people had died. The outcomes, though, could have been much worse, “potentially enormous,” the report stresses, with an already heavily burdened health system in the densely crowded hub of Lagos offering multiple opportunities for the disease to spread quickly beyond control. Instead, the report describes efforts that stopped the outbreak within “three generations” of infection — from Sawyer to 13 people, from three of those people to one more person each, and from one of those to three more people, whose infections were all recorded at the end of August. Among the resources enabling health officials to contain the virus within that time, the report says, was an operations center already in place (“National public health emergency preparedness agencies in the region, including those involved in Ebola responses,” the report says, “should consider the development of an EOC to improve the ability to rapidly respond to public health threats”). Coordination with that center, as well as previous outbreak responses, including to a major lead poisoning in 2010, and to eradicate polio helped.

The story of Senegal’s first case of Ebola includes a path that traversed two countries with outbreaks of the disease. It began in early August when a sick man traveled from Sierra Leone to Guinea to see a traditional healer. When he died there on August 10, his mother, sister and brother in Guinea were among those who prepared his body for burial. All got sick. The mother and sister wound up in an Ebola treatment center; the brother by then was on his way to Senegal. When he became sick there he sought care at a neighborhood health post, but didn’t, apparently, tell anyone that he had come from Guinea, or that he had contact with someone who had died. Healthcare workers in Guinea, though, acting on information provided by the mother and sister, contacted public health staff in Senegal, who, in turn got in touch with the man’s family in Senegal. CDC credits that quick, coordinated communication, as well as preparations by Senegal’s Ministry of Health and its partners with containing the disease there.